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PubMed2005

Social and biological determinants of cognitive aging.

The aging of populations increases the importance of cognitive function as a public health issue. The Whitehall II study is investigating influences on aging processes within social context, with tests in five domains of cognitive function (short-term memory, inductive reasoning, vocabulary, phonemic and semantic fluency). The tests have now been completed three times over a 10-year period, by participants initially aged 40-60 years. In mid-life, socioeconomic differences in cognitive function were large, while APOE genotype had little influence. Higher occupational status was strongly related to lower metabolic syndrome prevalence. This social-biological gradient illustrates that potential confounding of psychosocial, behavioral and biological effects on cognitive decline is an important consideration in etiologic research. Additionally, it highlights the importance for population health of the 'causes of the causes' of cognitive aging. Epidemiology contributes to our understanding of risk and protective factors for cognitive decline by showing the links between the wider determinants of health and biological markers such as glucose intolerance and the metabolic syndrome.

Age Factors↗
PubMed2004

Associations between sociodemographic and lifestyle factors and dietary quality among adolescents in Palma de Mallorca.

OBJECTIVE: We assessed associations between sociodemographic and lifestyle factors and dietary quality among adolescents. METHODS: Subjects were 445 adolescents (171 boys, 274 girls; 14 to 18 y old) selected from the Palma de Mallorca (Balearic Islands, Spain) school census (96% participation) using two-stage probability sampling. The study protocol included dietary intake by means of a validated semiquantitative food-frequency questionnaire; sociodemographic factors of sex, maternal level of education, parental occupational status, and maternal region of origin; physical activity; and body weight and height measurements. Body mass index was calculated and energy intake expressed as multiples of basal metabolic rate. RESULTS: Mean daily energy intakes were 12.9 MJ for boys and 12.0 MJ for girls. Boys showed a higher percentage of energy from carbohydrates but a lower percentage from proteins and fat than did girls (44.9 versus 41.6, 18.8 versus 19.8, and 36.3 versus 38.5, respectively). Dietary fiber intake was within the recommended levels. Mineral and vitamin intakes generally met their estimated needs, except for vitamins A and D, which covered less than two-thirds of the recommended intake. Maternal educational level was positively correlated with dietary mineral and vitamin intakes. A positive relation between physical activity and dietary intakes of carbohydrate and of mineral and vitamin was found. CONCLUSIONS: Maternal level of education and physical activity are associated to the quality of diet among adolescents in Palma de Mallorca.

Adolescent↗
PubMed2005

Breastfeeding initiation and duration in Lebanon: are the hospitals "mother friendly"?

Eight hundred and thirty mothers and their children aged 1 to 5 years were studied to identify the determinants of breastfeeding initiation and perseverance in relation to hospital policies. Only 18.3% of the mothers initiated breastfeeding within half an hour after birth. Mothers whose baby was brought to them every 3 hours or less were 2.5 times and mothers whose infants were brought to them for night feedings were 3 times more likely to initiate breastfeeding a few hours after birth. Mother's occupational status and whether she was breastfed were significantly associated with breastfeeding duration.

Adult↗
PubMedDate not supplied

Oxidative stress in pregnant women and birth weight reduction.

The purpose of this study is to evaluate the role of maternal oxidative stress in lowering neonatal birth weight. Women (N=261) with singleton pregnancy were analyzed for biomarker levels of oxidative stress after recruitment at the time of hospitalization for delivery in Korea between 2000 and 2001. Among the neonates, 247 births were full-term infants and 14 births were pre-term infants. Biomarkers measured for oxidative stress were maternal urinary 8-hydroxydeoxyguanosine (8-OH-dG) and malondialdehyde (MDA). The women with pre-term infants had higher concentrations of urinary 8-OH-dG and MDA than those with full-term babies. The concentrations of maternal urinary 8-OH-dG and MDA were inversely associated with birth weight of full-term deliveries after adjusting for potential confounders including maternal age, body mass index, dietary intake, alcohol consumption, smoking exposure, occupational status, and neonatal sex (P<0.05). This study demonstrates that increase of 8-OH-dG and MDA concentrations in urine of pregnant women were associated with reduced birth weight in full-term deliveries.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2005

Association between psychosocial job characteristics and insomnia: an investigation using two relevant job stress models--the demand-control-support (DCS) model and the effort-reward imbalance (ERI) model.

BACKGROUND AND PURPOSE: The details of risky psychosocial job characteristics related to insomnia are unclear, although potential relationships between the two have been suggested. The study objective was to clarify these relationships by using the demand-control-support (DCS) model and the effort-reward imbalance (ERI) model. PATIENTS AND METHODS: A cross-sectional questionnaire survey was conducted with 1081 middle-aged (39 years and older) workers in a corporate group of electric products in Osaka, Japan. The study variables included insomnia symptoms (non-refreshing sleep, difficulty falling asleep, frequent sleep disruption, and early morning arousal) and psychosocial job characteristics which were evaluated using the DCS and ERI models, gender, age, disease, sleep-related factors, occupational status, and health practices. RESULTS: ERI [odds ratio (95% confidence interval): 2.27 (1.43, 3.60)], overcommitment [1.86 (1.40, 2.47)], and high job strain [1.55 (1.12, 2.15)] were independently associated with insomnia. The odds ratio of insomnia for individuals with high job strain was increased by adding ERI or overcommitment. CONCLUSIONS: The ERI and DCS models describe the adverse psychosocial job characteristics related to insomnia. Simultaneously employing these two models is more useful than employing a single model to identify workers at risk of insomnia. The conceptual framework derived from the job stress models assists in defining preventive measures for insomnia in workers.

Adult↗
PubMed2005

The role of mediating factors in the association between social deprivation and low birth weight in Germany.

This study examines whether the association between social inequalities and low birth weight (LBW) (occurring in both pre- and full-term births) in Germany can be explained by several potentially confounding factors. These include maternal age, occupational status, marital status, nationality, employment status, smoking, prenatal care, psychosocial stress, obesity, short stature, short inter-pregnancy interval, chronic conditions, and several obstetrical risk factors such as pregnancy induced hypertension. We also examined how the risk for LBW varies over time within each socioeconomic group. We analyzed routinely collected perinatal data on singletons born in the federal state of Lower Saxony, Germany, in 1990, 1995, and 1999 (n = 182,444). After adjustment for all potentially confounding factors in multivariate logistic regression models, working class women, unemployed women, single mothers, and women over 39 years of age were at increased risk for pre- and full-term LBW infants. Migrant status was not related to LBW. We examined variations in the risk for LBW over time within groups, using the 1990 birth cohort as the referent group for the 1995 and 1999 birth cohorts. Compared to 1990, in 1999 women aged 19-34 years, housewives, unemployed women, women of German nationality and women with partners had higher risks for pre- and full-term LBW infants; the eldest subgroup had lower risks for LBW after adjustment for confounding factors. The factors we examined partly explain the social inequalities in LBW occurring in pre- and full-term infants. The subgroups with higher rates of LBW in 1999 compared to 1990, included women experiencing childbirth in an optimal stage of life or in a privileged social context. Public health policies in Germany should target social inequalities contributing to the aetiology of LBW and to the factors that result in increased LBW rates.

Adolescent↗
PubMed2006

Factors associated with the use of maternity services in Enugu, southeastern Nigeria.

The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<0.05). We conclude that factors which will positively influence women to deliver in health institutions in Enugu, Nigeria include a variety of interacting social, economic and health system factors, which operate at various levels-the household, community, the health institutions and the larger social and political environment. Attention to these factors will not only improve maternity utilization but, hopefully, also will reduce the high maternal mortality and improve other maternal health indicators in the study area.

Adolescent↗
PubMed2005

Factors influencing influenza vaccination uptake in an elderly, community-based sample.

This study investigated predictors of influenza vaccination uptake since the introduction of the policy to target over 65s. Four hundred and forty-four participants completed a cross-sectional structured interview. The predictors of vaccination uptake were: having a doctor or nurse who explained why the vaccination is important and possible side effects; living with others; higher occupational status; and having a car or being able to walk to the GPs rather than reliant on others or public transport. Most participants who had received the vaccination reported having done so in response to reminders or advice from medical professionals. The most common explanations given by those who had chosen not to receive the vaccination were fear of side effects and concerns regarding vaccination efficacy. Current national campaigns and general practitioners' reminder programmes appear to have been successful in improving awareness; however, these results suggest that a more informational campaign, focused on the evidence that the vaccine is efficacious and that side effects are limited, may further improve uptake.

Aged↗
PubMed2002

Cigarette smoking and the risk of rheumatoid arthritis among postmenopausal women: results from the Iowa Women's Health Study.

PURPOSE: To determine whether cigarette smoking increases the risk of rheumatoid arthritis among postmenopausal women. SUBJECTS AND METHODS: We followed a cohort of 31 336 women in Iowa who were aged 55 to 69 years in 1986 and who had no history of rheumatoid arthritis. Through 1997, 158 cases of rheumatoid arthritis were identified and validated based on review of medical records and supplementary information provided by physicians. Multivariable Cox proportional hazards regression was used to derive rate ratios (RRs) and 95% confidence intervals (CIs) for the association between cigarette smoking and rheumatoid arthritis. RESULTS: Compared with women who had never smoked, women who were current smokers (RR = 2.0; 95% CI: 1.3 to 2.9) or who had quit 10 years or less before study baseline (RR = 1.8; 95% CI: 1.1 to 3.1) were at increased risk of rheumatoid arthritis, but women who had quit more than 10 years before baseline were not at increased risk (RR = 0.9; 95% CI: 0.5 to 2.6). Both the duration and intensity of smoking were associated with rheumatoid arthritis. Multivariable adjustments for age, marital status, occupation, body mass index, age at menopause, oral contraceptive use, hormone replacement therapy, alcohol use, and coffee consumption did not alter these results. CONCLUSION: These results suggest that abstinence from smoking may reduce the risk of rheumatoid arthritis among postmenopausal women.

Aged↗
PubMedDate not supplied

The tridimensional personality model: influencing variables in a sample of detoxified alcohol dependents. European Fluvoxamine in Alcoholism Study Group.

C.R. Cloninger proposed a biosocial model for personality, linking personality traits to patterns of responses to various external stimuli, including alcohol. The Tridimensional Personality Questionnaire (TPQ) was administered in a multicenter study to detoxified alcohol-dependent patients (N = 521). The objectives of the study were to evaluate (1) the expression of the three personality dimensions, novelty-seeking (NS), harm avoidance (HA), and reward dependence (RD), of the TPQ in this sample, and (2) the influence of different variables on these personality dimensions. The following variables were selected for a multiple and a stepwise regression analysis: sex, family history for major psychiatric disorders, marital status, occupation, age at study enrollment, age of onset of alcoholism, serum cholesterol level, intake of neuroleptics or benzodiazepines for detoxification, and severity of depression and anxiety. In comparison to Austrian normative data, both sexes of detoxified alcohol addicts scored higher in HA. The variables examined explain 23% of the variance of NS and 35% of HA. Only one variable, namely age of onset, is significantly influencing NS (19% explained variance). HA is significantly influenced by three variables: anxiety state, anxiety trait, and sex (32% explained variance). RD is not influenced by any of the variables examined.

Adult↗
PubMed2003

Destructive periodontal diseases in minority populations.

Disparities in the prevalence and severity of destructive periodontal diseases have been reported for American minority populations and have raised the following questions. Are differences in destructive periodontal disease prevalence and severity due to genetic or other confounding variables associated with ethnicity race? Do risk factors for destructive periodontal diseases differ among American minority populations or differ from the population at large? Answers to these questions will have profound impact on the direction of future research and the allocation of resources to address disparities in destructive periodontal diseases in American minority populations. Risk assessment studies that examined a set of clinical, demographic, immunologic, and microbiologic parameters of Asian Americans, African Americans, and Hispanic Americans resident in the greater New York City region suggest that occupational status, monitored as a surrogate variable for socioeconomic status, may be a more robust risk factor than ethnicity/race for destructive periodontal diseases in these populations.

Adult↗
PubMed1979

Plasma lipids, lipoproteins, and blood pressure in female adolescents using oral contraceptives.

Comparative profiles are reported for plasma lipids and lipoproteins, blood pressure, smoking, and selected socioeconomic variables for females less than 20 years of age using oral contraceptives and for pair-matched non-users from the Lipid Research Clinics Prevalence Study. About 5% of adolescent females reported OC use; they had significantly higher levels of plasma total cholesterol, triglyceride, and high-density lipoprotein-cholesterol than did the non-users. Significantly more non-users of OC belonged to households of the lowest occupational status; no differences in OC usage by educational status of the head of household were discernible. Of the OC users, 58% were classified as current smokers, as compared with 23% of the non-OC users.

Adolescent↗
PubMed1990

Relationship of social class characteristics and risk factors for coronary heart disease in West Germany.

A cross-sectional analysis of the baseline survey of the German Cardiovascular Prevention Study was carried out to analyse the relationship between four different social class characteristics and major risk factors for coronary heart disease. 4,796 randomly selected German residents aged 25-69 years participated in the health survey between 1984 and 1986. The response rate was 66.2%. No significant association with social class variables was observed for prevalence of hypertension, hypercholesterolaemia or low high density lipoproteins. Multiple logistic regression analysis showed that obesity and lack of physical activity were significantly more prevalent in lower social classes for both sexes, while for cigarette smoking this relationship held for males only. The strongest social class gradient was found for lack of physical activity, adjusted odds ratio 4.75, P less than 0.001, comparing lowest social class by composite index to highest. The number of coronary heart disease risk factors per study subject increased strongly with decreasing social class. Education, measured as years of schooling, showed a stronger association with coronary heart disease risk factors than household income, occupational status, or a three-dimensional composite index of social class. These findings indicate the need to focus on lower social class population groups when carrying out community-based coronary heart disease primary prevention programmes, particularly with regard to smoking, obesity, and lack of physical activity.

Adult↗
PubMed1994

The relation of socioeconomic factors to the incidence of proliferative diabetic retinopathy and loss of vision.

PURPOSE: To investigate the relations between socioeconomic factors and the incidence of proliferative retinopathy and loss of vision. METHODS: A population-based sample of younger-onset persons with diabetes 25 years of age or older (n = 334) and older-onset persons with diabetes (n = 906) was followed over a 4-year period. Education, occupational status, employment status, and marital status were measured at baseline and follow-up. Main outcome measures were incidence of proliferative retinopathy and loss of vision measured using standard protocols. RESULTS: Proliferative retinopathy was more likely to develop in younger-onset women with less education than in those with more education; no relation was found in the older-onset group. Education was associated inversely with incidence of loss of vision in younger-onset women and older-onset men. CONCLUSION: These data suggest that education is associated with the development of loss of vision, independent of other risk factors. The associations vary between men and women and between younger-onset and older-onset people with diabetes. Further understanding of these relationships may lead to interventions to prevent loss of vision in people with diabetes.

Adult↗
PubMed1997

Psychosocial predictors of depressive symptomatology level in postpartum women.

This study explored a multifactorial model for the prediction of the intensity of depressive symptoms in postpartum women. Data were gathered from 213 pregnant women during the second trimester of pregnancy and at 6 months postpartum. Participants were assessed according to a number of psychosocial variables. A path analysis indicated that four variables had a direct effect on postpartum depressive symptomatology level: lower occupational status, prenatal depression level, more distal stressors and a personal psychiatric history. Eight variables, which reflected past and present experiences, showed an indirect effect. The implications of these findings are discussed.

Adult↗
PubMedDate not supplied

[Prevalence of sleep disorders in Madrid, Spain].

INTRODUCTION: Sleep disorders are among the clinical entities with a great health and socioeconomic impact. So far, in Spain there are isolated epidemiologic data, lacking from studies that cover the full spectrum of sleep disorders in the general adult population. METHODS: A sample of 1,500 adult subjects from Madrid were interviewed during the first semester of 1990, using a clinical questionnaire including sociodemographic data, habits, sleep disorders, and information regarding somatic and psychiatric pathology. A detailed analysis of the influence of sex, age and occupational status on the prevalence of the different disorders is presented. RESULTS: 1,131 persons (75.4%) completed the interview. 22.8% (95% confidence interval, CI: 20.4-25.4) referred at least one sleep difficulty, 11.3% (9.5-13.3) of the sample complained of insomnia, this being more common in women, older individuals and unemployed. Daytime sleepiness was reported by 11.6% (9.8-13.7) of the sample, and 3.2% (2.2-4.4) referred hypersomnia, with sleep attacks and sleep paralysis being rarely found. Regarding parasomnias, 12.3% (10.4-14.4) had nightmares, with the prevalence of sonambulism, night terrors and enuresis being near 1%. Daily snoring was present in 11.9% (10.1-14.0) of the sample, whereas 1.1% (0.6-2.0) reported respiratory pauses during the night. CONCLUSIONS: A high prevalence of sleep disorders is estimated in the adult population of the city of Madrid, Spain. Our data are in general similar to those found in other countries, and differences found are discussed.

Adolescent↗
PubMed1997

A qualitative study of sexual harassment of female doctors by patients.

This paper reports the qualitative data from a study of sexual harassment of female family physicians by patients. In addition to the everyday harassment that any woman might encounter in a work setting, the physicians in this study also reported types of harassment which are unique to the practice of medicine. These include opportunistic harassment such as exposure of the genitals, inappropriately touching the physician when the examination requires close contact, excessive discussion of sexual matters for apparent erotic gratification, and acting out behaviours from non-competent patients. Other reported behaviours were not, strictly speaking, sexual harassment but were troublesome nonetheless, including spontaneous erections during physical examinations, physically intimidating behaviour, and ambiguous behaviours which were sexual in nature, but difficult to interpret. The findings are discussed in the context of theory pertaining to contrapower harassment. It is concluded that for some patients the gender of the physician takes precedence over her occupational status and, this combined with the unique characteristics of the doctor/patient relationship, can make the practice of family medicine more conductive to sexual harassment than other professions.

Acting Out↗
PubMed1999

The persisting effect of unemployment on health and social well-being in men early in working life.

In our studies of the effects of unemployment in the early working life of men in a British national birth cohort we have shown elsewhere that this experience was part of a longer term accumulation of social and health disadvantage. This present study asks whether men's unemployment also inflicted potential longterm damage to future socio-economic chances and health. We therefore constructed indicators of socio-economic circumstances and health at 33 years from factors already shown to be associated with health in later life. For the socio-economic indicator we used a combination of income, occupational status and home ownership and described this as socio-economic capital. For the health indicator we combined scores of body mass index, leisure time exercise, frequency of eating fresh fruit and of smoking, and described this as health capital. After controlling for pre-labour market socio-economic and health factors, prolonged unemployment is shown here to reduce significantly both socio-economic and health capital by age 33 years. We conclude that the experience of prolonged unemployment early in the working life of this population of young men looks likely to have a persisting effect on their future health and socio-economic circumstances.

Adolescent↗